Rubella usually is a mild, febrile rash illness in children and adults; however, infection early in pregnancy, particularly during the first 16 weeks, can result in miscarriage, stillbirth, or an infant born with birth defects (i.e., congenital rubella syndrome [CRS]) (1). As of 2013, goals to eliminate rubella have been established in two World Health Organization regions (the Region of the Americas by 2010 and the European Region by 2015), and targets for accelerated rubella control and CRS prevention have been established by the Western Pacific Region (WPR) (2). In 1976, Japan introduced single-antigen rubella vaccine in its national immunization program, targeting girls in junior high school. In 1989, a measles-mumps-rubella (MMR) vaccine was introduced, targeting children aged 12–72 months. However, adult males remain susceptible to rubella. From January 1 to May 1, 2013, a total of 5,442 rubella cases were reported through the rubella surveillance system in Japan, with the majority (77%) of cases occurring among adult males. Ten infants with CRS were reported during October 2012–May 1, 2013. Countries and regions establishing a goal of accelerated control or elimination of rubella should review their previous and current immunization policies and strategies to identify and vaccinate susceptible persons and to ensure high population immunity in all cohorts, both male and female.

During 1999–2007, rubella surveillance in Japan consisted of aggregate case reporting to the pediatric sentinel surveillance system. Cases were reported from a representative sample of approximately 3,000 pediatric inpatient and outpatient medical facilities. In January 2008, the sentinel surveillance systems were replaced by nationwide case-based surveillance for rubella, and all physicians were required to report any clinically diagnosed or laboratory-confirmed rubella case* to local health officials. In April 1999, nationwide, case-based surveillance for CRS† had been established.

Until the early 2000s, rubella was endemic in Japan, with periodic epidemics approximately every 5 years and seasonal increases in the spring and summer. The number of reported rubella cases remained at record low levels until 2010, and in 2011, a few outbreaks were reported in the workplace among adult males. In 2012, the number of rubella cases sharply increased to 2,392, with the rise in cases continuing into 2013 (Figure 1). From January 1 to May 1, 2013, a total of 5,442 rubella cases were reported (Table). 

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